Meningitis, Viral
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Basics
Description
- A clinical syndrome characterized by fever with signs/symptoms of acute meningeal inflammation (including but not limited to headache, photophobia, neck stiffness, and/or nausea/vomiting)
- Viral meningitis (VM) is the most common cause of aseptic (nonbacterial) meningitis.
- System(s) affected: nervous
Epidemiology
Incidence
- Estimated 75,000 VM cases caused by enterovirus annually in the United States
- Most common form of meningitis
- Peaks summer to fall in temperate climates (but is year round in subtropical or tropical climates)
- Nonpolio enteroviruses are the most common cause of viral meningitis.
Etiology and Pathophysiology
- In immunocompetent hosts, VM is a rare complication of an acute viral infection like gastroenteritis, mumps, HSV, VZV, and arthropod-borne viruses.
- Case reports in the literature indicate that SARS-CoV-2 can also cause VM as a rare complication.
- In immunocompromised hosts, viral pathogens may also include CMV and EBV.
- 23–61% of VM cases are caused by nonpolio human enteroviruses. These viruses are typically transmitted via the fecal-oral route.
- Mosquito-borne viruses include West Nile, Zika, chikungunya, dengue, St. Louis encephalitis virus, and Eastern equine encephalitis virus. Tick-borne viruses include Powassan virus, Colorado tick fever virus, tick-borne encephalitis virus.
- Recurrent benign lymphocytic (Mollaret) meningitis is generally associated with HSV-2 (80% of cases).
Genetics
None identified
Risk Factors
- Close contacts of people with VM are unlikely to get VM but may get the primary viral syndrome.
- Age (most common in children <5 years)
- Babies <1 month of age are more likely to have severe disease.
- Immunocompromised host (patients more susceptible to CMV, HSV, and EBV)
Geriatric Considerations
Cases of VM in the elderly are rare (most common cause is VZV, HSV); consider alternative diagnoses (e.g., cancer, medication-induced aseptic meningitis).
General Prevention
- Practice hand washing and general hygiene procedures.
- Avoid sharing drinks/cups and silverware with others, especially those who are ill.
- Avoid exposure to mosquitos and ticks; if outdoors, recommend use of appropriate clothing, DEET, and mosquito nets.
Commonly Associated Conditions
Encephalitis; myopericarditis; neonatal enteroviral sepsis; meningoencephalitis; flaccid paralysis
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Basics
Description
- A clinical syndrome characterized by fever with signs/symptoms of acute meningeal inflammation (including but not limited to headache, photophobia, neck stiffness, and/or nausea/vomiting)
- Viral meningitis (VM) is the most common cause of aseptic (nonbacterial) meningitis.
- System(s) affected: nervous
Epidemiology
Incidence
- Estimated 75,000 VM cases caused by enterovirus annually in the United States
- Most common form of meningitis
- Peaks summer to fall in temperate climates (but is year round in subtropical or tropical climates)
- Nonpolio enteroviruses are the most common cause of viral meningitis.
Etiology and Pathophysiology
- In immunocompetent hosts, VM is a rare complication of an acute viral infection like gastroenteritis, mumps, HSV, VZV, and arthropod-borne viruses.
- Case reports in the literature indicate that SARS-CoV-2 can also cause VM as a rare complication.
- In immunocompromised hosts, viral pathogens may also include CMV and EBV.
- 23–61% of VM cases are caused by nonpolio human enteroviruses. These viruses are typically transmitted via the fecal-oral route.
- Mosquito-borne viruses include West Nile, Zika, chikungunya, dengue, St. Louis encephalitis virus, and Eastern equine encephalitis virus. Tick-borne viruses include Powassan virus, Colorado tick fever virus, tick-borne encephalitis virus.
- Recurrent benign lymphocytic (Mollaret) meningitis is generally associated with HSV-2 (80% of cases).
Genetics
None identified
Risk Factors
- Close contacts of people with VM are unlikely to get VM but may get the primary viral syndrome.
- Age (most common in children <5 years)
- Babies <1 month of age are more likely to have severe disease.
- Immunocompromised host (patients more susceptible to CMV, HSV, and EBV)
Geriatric Considerations
Cases of VM in the elderly are rare (most common cause is VZV, HSV); consider alternative diagnoses (e.g., cancer, medication-induced aseptic meningitis).
General Prevention
- Practice hand washing and general hygiene procedures.
- Avoid sharing drinks/cups and silverware with others, especially those who are ill.
- Avoid exposure to mosquitos and ticks; if outdoors, recommend use of appropriate clothing, DEET, and mosquito nets.
Commonly Associated Conditions
Encephalitis; myopericarditis; neonatal enteroviral sepsis; meningoencephalitis; flaccid paralysis
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